Nothing is more frustrating than having a “simple” injury (e.g., a “simple ankle sprain” or a “simple muscle pull”) that doesn’t improve. “Simple” tennis elbow often qualifies.
In our June/July, 2016 newsletter, we outlined how age may influence true tendon injuries with “lateral epicondylitis” (the fancy name for tennis elbow). This already makes recovery challenging, but further complicating matters is that often the pain is not a tendon injury at all, leading some to say the complaint should just be called “lateral elbow pain syndrome.”
Another common cause is from joint compression, involving either soft tissues pinched between the upper arm bone (humerus) and the outside forearm bone (radius) or compressing the surfaces of the joint itself. Alternatively, the radial nerve can get stretched or pinched as it runs over the outside of the elbow or forearm. Stiffness or a faulty position of the radius may alter normal mechanics in either of these conditions.
Here are a few tests you can do to help distinguish the source of your lateral elbow pain.
Hold your injured arm straight out in front of you with knuckles up. Bend the hand up and toward your body and then use the opposite hand to try to push the hand down and away.
Repeat the test but this time bend the hand up and away from your body and use the opposite hand to try to push the hand down and inwards. If the first way hurts MORE than the second, you likely have an injury to the muscles/tendons. If they hurt equally, it is more likely joint-related.
To double check, use your uninjured hand to passively bend the injured elbow. Perform with the palm up, palm down, and ½ way in between, and then passively straighten the elbow with the palm up and down. If any of these hurt, since the muscles are relaxed, the pain is likely joint-related.
If the elbow joint doesn’t hurt to the touch but the pain is a couple of inches down your forearm and “dull,” it could be a radial nerve injury. To test, with the arm relaxed by your side, elbow bent to 90 degrees and palm facing in, use your other hand to try to turn the forearm palm down but don’t let it move! If the achiness in your arm increases, your radial nerve is likely getting compressed.
Treatment depends on the affected tissue and is beyond the space here but your results to these tests may at least tell you why your simple elbow problem isn’t so simple.
Tom Fontana, PT